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MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
MEDICAL STAFF OF ST JOHN & WEST SHORE HOSPITAL (EIN 34-1663333)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-05-12
IRS object ID
201531329349302683
Schema version
2014v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-05-12T14:05:19-04:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN311505872PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Sauppe Tax Service LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line132650 Greenwood DrAddressLine1Txt
CityAvon LakeCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44012ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN341663333EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Medical Staff of St John Westshore HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMEDIBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line129000 Center Ridge RdAddressLine1Txt
CityWestlakeCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44145ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAdnan Mournay MDPersonNm
Person TitlePresidentPersonTitleTxt
Phone4408275536PhoneNum
Signature2015-05-06SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJanice SauppePreparerPersonNm
PTINP00014757PTIN
Phone4409333178PhoneNum
Preparation2015-05-12PreparationDt
Self EmployedYes (X)SelfEmployedInd
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts$247,686GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressN/AWebsiteAddressTxt
Type Of Organization AssocYes (X)TypeOfOrganizationAssocInd
Formation1981FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionContinuing Medical Education to keep doctors up to date on medical issuesActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers122TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$186,800PYContributionsGrantsAmt
CY Contributions Grants$213,879CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$13,537PYInvestmentIncomeAmt
CY Investment Income$33,807CYInvestmentIncomeAmt
PY Other Revenue$72,080PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$272,417PYTotalRevenueAmt
CY Total Revenue$247,686CYTotalRevenueAmt
PY Grants And Similar Paid$12,664PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$11,353CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$20,642PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$24,834CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$134,000PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$134,000CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$37,452PYOtherExpensesAmt
CY Other Expenses$24,032CYOtherExpensesAmt
PY Total Expenses$204,758PYTotalExpensesAmt
CY Total Expenses$194,219CYTotalExpensesAmt
PY Revenues Less Expenses$67,659PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$53,467CYRevenuesLessExpensesAmt
Total Assets BOY$589,883TotalAssetsBOYAmt
Total Assets EOY$641,489TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$589,883NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$641,489NetAssetsOrFundBalancesEOYAmt
MissionContinuing Medical Education to keep doctors up to date on medical issuesMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$55,562ExpenseAmt
DescOngoing medical training and conferencing for hospital medical staffDesc
Total Program Service Expenses$55,562TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document11IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyfalseConflictOfInterestPolicyInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonAdnan Mournay MDPersonNm
Phone4408275536PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line129000 Center Ridge RdAddressLine1Txt
CityWestlakeCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44145ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
Adnan Mournay MD
President10.000.00Yes (X)Yes (X)$50,000$0$0
David Tolentino
Vice President5.000.00Yes (X)Yes (X)$0$0$0
Kornelia Solymos MD
Secretary Treasurer5.000.00Yes (X)Yes (X)$1,000$0$0
James H Myers
Dept Chair5.000.00Yes (X)$12,000$0$0
Jeffrey Christian
Dept Chair5.000.00Yes (X)$11,000$0$0
Edwina Simmons MD
Dept Chair0.000.00Yes (X)$1,000$0$0
Manuel Martinez MD
Dept Chair0.000.00Yes (X)$1,000$0$0
Matthew Kacir
Dept Chair5.000.00Yes (X)$12,000$0$0
John Coletta
Dept Chair5.000.00Yes (X)$12,000$0$0
Robert Stern MC
Dept Chair5.000.00Yes (X)$12,000$0$0
Mehrun Elyaderani
Dept Chair5.000.00Yes (X)$11,000$0$0
John Wolf
Dept Chair5.000.00Yes (X)$11,000$0$0
Amelia Llerena MD
Immediate Past President5.000.00Yes (X)$0$0$0
Gregory Bloxforf DO
Member At Large5.000.00Yes (X)$0$0$0
Charles Duncan MD
Member At Large5.000.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$134,000TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Membership Dues$146,879MembershipDuesAmt
Related Organizations$67,000RelatedOrganizationsAmt
Total Contributions$213,879TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$33,807TotalRevenueColumnAmt
Related Or Exempt Func Income$33,807RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$247,686TotalRevenueColumnAmt
Related Or Exempt Func Income$33,807RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$11,353TotalAmt
Program Services$11,353ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$24,834TotalAmt
Program Services$24,834ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$134,000TotalAmt
Management And General$134,000ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$490TotalAmt
Management And General$490ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$325TotalAmt
Management And General$325ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$634TotalAmt
Management And General$634ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$19,375TotalAmt
Program Services$19,375ProgramServicesAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescGifts to VolunteersDesc
Total$3,208TotalAmt
Management And General$3,208ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$194,219TotalAmt
Program Services$55,562ProgramServicesAmt
Management And General$138,657ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$114,033BOYAmt
EOY$135,092EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$335,688BOYAmt
EOY$366,719EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$140,162BOYAmt
EOY$139,678EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$589,883BOYAmt
EOY$641,489EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$589,883BOYAmt
EOY$641,489EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$589,883BOYAmt
EOY$641,489EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$589,883BOYAmt
EOY$641,489EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$53,467ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$1,861NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Other Assets Org OtherAssetsOrgGrp (6 entries)

DescDescBook ValueBookValueAmt
Ally Bank CD$25,058
Ally Bank CD$25,105
Ally Bank CD$20,044
Barclays Bank CD$24,776
Barclays Bank CD$24,712
Goldman Sachs CD$19,983
FieldValueIRS element (for citing)
Total Book Value Other Assets$139,678TotalBookValueOtherAssetsAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdIRC SectionIRCSectionDescCash GrantCashGrantAmtRecipient EINRecipientEIN
St John Medical Center
29000 Center Ridge RdWestlakeOH44145501c3$4,053
United Way Foundation
1331 Euclid AveClevelandOH44115501c3$600131635294
Harvest for Hunger
15500 South Waterloo RdClevelandOH44110501c3$3,000
The Welcome House
802 Sharon DrWestlakeOH44145501c3$200341793226
VNA of Ohio Hospice
2500 East 22nd StClevelandOH44115501c3$200341638790
Westshore Ostepathic Foundation
29101 Health Campus Dr Ste 150WestlakeOH44145501c3$1,500341207772
Hospice of Western Reserve
300 E 185th StClevelandOH44114501c3$200341256377
Lakewood United Methodist Church
15700 Detroit RdLakewoodOH44107501c3$200
St Mary of the Falls Church
25615 Bagley RdOlmsted FallsOH44138501c3$200
Mt Sinai Health Care Foundation
11000 Euclid AveClevelandOH44106501c3$200341777878
Lisa Hagan Berry Memorial Fund
3430 Rocky River DrClevelandOH44111501c3$500
Ohio Physicians Health Program
5900 Roche Dr Ste 440ColumbusOH43229501c3$500341817218

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceMonitoring procedures (Part I, line 2)FormAndLineReferenceDesc
ExplanationReceipts are kept for all donations madeExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Officer directors etc family relationship Part VI line 2Officers, trustees, etc. may consult and work together on patient care but there is no family or direct business relationships
Member election for additional members Part VI line 7aAll officers and department chairs are elected by the general membership by paper ballot
Governing body decisions Part VI line 7bAll governing decisions are voted upon by the membership and must have a majority approval to pass.
Form 990 governing body review Part VI line 11A complete copy of the 990 is available for review by all members of the governing body before the return is filed.
Governing documents etc available to public Part VI line 19These documents are available upon request